A study published in the December 15, 2008 issue of the Journal of Clinical Sleep Medicine suggests that screening patients with Type 2 diabetes for obstructive sleep apnea (OSA) and treating those who have obstructive sleep apnea with continuous positive airway pressure (CPAP) and bi-level positive airway pressure (bi-level/BiPAP), or generically xPAP, therapy could improve the management of their hyperglycemia and might favorably influence their long-term prognosis.
According to Arthur Dawson, M.D., division of Chest and Critical Care Medicine, Scripps Clinic Sleep Center, La Jolla, California, it is not surprising that many diabetics have sleep apnea since Type 2 diabetes and obstructive sleep apnea are both conditions that are becoming much more common because of the obesity epidemic.
"The low blood oxygen level and the arousals associated with an apneic event activate the sympathetic nervous system and cause the release of stress hormones, both of which tend to raise the blood glucose. If we could prevent these apneic events with CPAP or bi-level/BiPAP, then we might keep the glucose level lower and more stable through the night," said Dawson.
For the study, 20 patients with Type 2 diabetes who were on a stable diabetic regime were recruited at the time of their initial consultation with a sleep physician. All participants were newly diagnosed with moderate to severe obstructive sleep apnea, and none had any previous experience with CPAP or bi-level positive airway pressure/BiPAP".
Glucose level was monitored with a continuous glucose monitoring system (CGMS) over a period of 36 hours, which included a night in a sleep laboratory for evaluation by polysomnography. On the first night of the study, patients’ obstructive sleep apnea was untreated.
A second night of glucose monitoring and sleep recording was done after the participants had been on xPAP therapy for a duration of one-to-three months. No changes were made in participants’ diets or medication for diabetes throughout the study.
Results showed that in a group of 20 patients with Type 2 diabetes who were mostly obese and were newly diagnosed with obstructive sleep apnea, sleeping and nocturnal hyperglycemia were reduced and the sleeping interstitial glucose level was less variable during xPAP treatment.
The average glucose level during sleep decreased by approximately 20mg/dL after an average of 41 days of xPAP. The sleeping glucose also was more stable after treatment, with the median standard deviation decreasing from 20.0 to 13.0 and the mean difference between maximum and minimum values decreasing from 88 to 57.
The authors believe that recognizing and treating obstructive sleep apnea could improve the outlook for diabetics who also suffer from obstructive sleep apnea. Researchers involved in this study theorized that by using the CGMS they were able to pick up short-term changes in the glucose level that would not be detected by traditional measurements.
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